Healthy gums should be pink, firm and keep your teeth securely in place. Your gums should not bleed when you touch or brush them.

Gum disease is not always painful and you may be unaware you have it.

It's important to have regular dental check-ups.

Early symptoms of gum disease

Gum disease is not always painful and you may be unaware you have it.

The initial symptoms of gum disease can include:

• red and swollen gums
• bleeding gums after brushing or flossing your teeth

This stage of gum disease is called gingivitis.

Advanced symptoms

If gingivitis is untreated, the tissues and bone that support the teeth can also become affected. This is known as periodontitis, or periodontal disease.

Symptoms of periodontitis can include:

• bad breath (halitosis)
• an unpleasant taste in your mouth
• loose teeth that can make eating difficult
• collections of pus that develop under your gums or teeth (gum abscesses)

Acute necrotising ulcerative gingivitis

In rare cases, a condition called acute necrotising ulcerative gingivitis (ANUG) can develop suddenly.

The symptoms of ANUG are usually more severe than those of gum disease and can include:

• bleeding, painful gums
• painful ulcers
• receding gums in between your teeth
• bad breath
• a metallic taste in your mouth
• excess saliva in your mouth
• difficulty swallowing or talking
• a high temperature (fever)

When to see a dentist

You should make an appointment to see your dentist if you think you may have gum disease or ANUG.

If you do not currently have a dentist, search for a dentist near you.

Find out more about treating gum disease

Gum disease can be caused by a number of factors, but poor oral hygiene is the most common cause.

Poor oral hygiene, such as not brushing your teeth properly or regularly, can cause plaque to build up on your teeth.

Plaque

Your mouth is full of bacteria that combine with saliva to form a sticky film known as plaque, which builds up on your teeth.

When you consume food and drink high in carbohydrates (sugary or starchy foods), bacteria in plaque turn carbohydrates into the energy they need, producing acid at the same time.

Over time, acid in plaque begins to break down your tooth's surface and causes tooth decay.

Other bacteria in plaque can also irritate your gums, making them inflamed and sore.

Plaque is usually easy to remove by brushing and flossing your teeth, but it can harden and form a substance called tartar if it's not removed. 

Tartar sticks much more firmly to teeth than plaque and can usually only be removed by a dentist or dental hygienist.

Who's most at risk?

As well as poor oral hygiene, a number of things can increase your risk of developing problems with your gums.

These include:

• smoking 
• your age – gum disease becomes more common as you get older
• diabetes – a lifelong condition that causes a person's blood sugar levels to become too high
• pregnancy – hormonal changes can make gums more vulnerable to plaque
• a weakened immune system – for example, because of conditions like HIV and AIDS or certain treatments, such as chemotherapy
• malnutrition – a condition that occurs when a person's diet does not contain the right amount of nutrients
• stress

You may also be more likely to have gum disease if you're taking medicines that cause a dry mouth. These medicines include antidepressants and antihistamines.

The best way to treat gum disease is to practise good oral hygiene, although additional dental and medical treatments are sometimes necessary.

Oral hygiene

Good oral hygiene involves:

• brushing your teeth for about 2 minutes last thing at night before you go to bed and on 1 other occasion every day – it does not matter if you use an electric or manual toothbrush, but some people find it easier to clean their teeth thoroughly with an electric toothbrush
• using toothpaste that contains the right amount of fluoride, a natural mineral that helps protect against tooth decay
• flossing your teeth or using interdental brushes regularly – preferably daily, before brushing your teeth
• not smoking
• regularly visiting your dentist – at least once every 1 to 2 years, but more frequently if necessary

See the teeth cleaning guide for more information and advice about how to keep your teeth clean.

Mouthwash

Antiseptic mouthwashes containing chlorhexidine or hexetidine are available over the counter from pharmacies.

But there's some debate about whether using mouthwash is necessary for people with healthy gums.

Mouthwashes cannot remove existing plaque. Only regular toothbrushing and flossing can do this.

Your dentist may recommend using mouthwash if it helps control the build-up of plaque, the sticky substance that forms when bacteria collects on the surface of your teeth.

Your dentist will be able to advise you about which type of mouthwash is most suitable and how to use it.

Chlorhexidine mouthwash can stain your teeth brown if you use it regularly.

Rinse your mouth thoroughly between brushing your teeth and using a chlorhexidine mouthwash as some ingredients in toothpaste can prevent the mouthwash working.  

You should not use a chlorhexidine mouthwash for longer than 4 weeks.

Dental treatments

Some of the dental treatments described here may also be recommended if you have gum disease.

Scale and polish

To remove plaque and tartar (hardened plaque) that can build up on your teeth, your dentist may suggest that you have your teeth scaled and polished.

This is a "professional clean" usually carried out at your dental surgery by a dental hygienist.

The dental hygienist will scrape away plaque and tartar from your teeth using special instruments, then polish your teeth to remove marks or stains.

If a lot of plaque or tartar has built up, you may need to have more than 1 scale and polish.

The price of a scale and polish can vary depending on what needs to be carried out, so ask your dental hygienist how much it'll cost beforehand.

Find out more about NHS dental charges

Root planing

In some cases of gum disease, root planing (debridement) may be required.

This is a deep clean under the gums that gets rid of bacteria from the roots of your teeth.

Before having the treatment, you may need to have a local anaesthetic (painkilling medication) to numb the area.

You may experience some pain and discomfort for up to 48 hours after having root planing.

Further treatment

If you have severe gum disease, you may need further treatment, such as periodontal surgery.

In some cases, it's necessary to remove the affected tooth.

Your dentist will be able to tell you about the procedure needed and how it's carried out. If necessary, they can refer you to a specialist.

If you're having surgery or root planing, you may be given antibiotics (medication to treat infections). Your dentist will tell you whether this is necessary.

Acute necrotising ulcerative gingivitis

Acute necrotising ulcerative gingivitis (ANUG) should always be treated by a dentist.

But if you see your GP before visiting a dentist, they may provide you with some treatment while you wait to see your dentist.

As well as the oral hygiene advice and dental treatments mentioned above, treatments for ANUG may also include antibiotics, painkillers and different types of mouthwash.

Antibiotics 

Treatment with antibiotics, such as metronidazole or amoxicillin, may be recommended if you have ANUG. You'll usually have to take these for 3 days.

Amoxicillin is not suitable for people allergic to penicillin.

Metronidazole can react with alcohol, causing you to feel very unwell. You should not drink alcohol while you're taking metronidazole and for 48 hours after you finish the course of treatment.

Other side effects of metronidazole and amoxicillin can include feeling sick, vomiting and diarrhoea.

Painkillers

Paracetamol and ibuprofen are the most commonly prescribed painkillers. 

They're also available over the counter from pharmacies. They may help reduce pain and discomfort.

But paracetamol and ibuprofen are not suitable for everyone, so read the manufacturer's instructions before taking them.

Mouthwash

Mouthwash containing chlorhexidine or hydrogen peroxide may be prescribed to treat ANUG.

Some chlorhexidine mouthwashes are also available over the counter, though they may not be as effective as a hydrogen peroxide mouthwash.

You should always read the instructions before using mouthwash. Some types may need to be diluted in water before they're used.

Stopping smoking

Smoking is one of the most significant risk factors for gum disease.

Giving up smoking can greatly improve your oral hygiene.

If you need help or advice about giving up smoking, call the free NHS Smokefree National Helpline on 0300 123 1044.

Your GP can give you information and advice about giving up smoking. You can also visit NHS Smokefree.

If you develop gingivitis and do not have the plaque or tartar (hardened plaque) removed from your teeth, the condition may get worse and lead to periodontitis.

You may develop further complications if you do not treat periodontitis, where the tissue that supports teeth is affected.

These include:

• recurrent gum abscesses (painful collections of pus)
• increasing damage to the periodontal ligament (the tissue that connects the tooth to the socket)
• increasing damage to and loss of the alveolar bone (the bone in the jaw that contains the sockets of the teeth)
• receding gums
• loose teeth
• loss of teeth

Acute necrotising ulcerative gingivitis

If you have acute necrotising ulcerative gingivitis (ANUG) and it's not treated, it can cause more severe complications.

The infection can spread to all areas of your gums and the alveolar bone surrounding your teeth.

This can lead to:

• the gums between your teeth being completely destroyed
• large ulcers (open sores) leaving permanent holes in your gums
• loose and unstable teeth

If ANUG is not properly treated the first time you have it, you're more likely to have recurring cases in the future.

This can cause persistent bad breath (halitosis) and bleeding gums, as well as gradually receding gums.

In rare cases, ANUG can lead to gangrene affecting the lips and cheeks. This occurs when tissue starts to die and waste away.

If you develop gangrene, you may need to have the dead tissue removed.

Other complications

Gum disease has also been associated with an increased risk for a number of other health conditions, including:

• cardiovascular disease
• lung infections
• premature labour and having a baby with a low birth weight if you're affected during pregnancy

But while people with gum disease may have an increased risk of these problems, there's not currently any clear evidence that gum disease directly causes them.